Brain, Vol 120, Issue 9 1579-1586, Copyright © 1997 by Oxford University Press
J Netz, T Lammers and V Homberg
Motor evoked responses to focal transcranial magnetic stimulation were
investigated over the unaffected hemisphere in 15 patients with hemiparesis
after ischaemic stroke and compared with data from normal control subjects.
Whereas responses to muscles ipsilateral to the stimulated hemisphere could
only be elicited at maximal intensities in two out of 12 normal control
subjects, such ipsilateral responses were recorded after stimulation of the
unaffected hemisphere in patients with poor recovery after stroke at
significantly lower thresholds, but not in patients with good recovery.
These responses occurred with a somewhat longer (on average 6 ms) latency
than the typical contralateral response. The duration of the silent period
ipsilateral to stimulation of the unaffected hemisphere was longer than in
control subjects. Also the contralateral threshold for the unaffected
hemisphere was elevated in comparison with the control group. In one
patient, who developed mirror movements after stroke, the ipsilateral
threshold was exceptionally low and the latency of the ipsilateral response
identical to that seen contralaterally. It is concluded that the motor
outputs in the unaffected hemisphere are significantly changed after
stroke, including the unmasking of ipsilateral corticospinal projections.
However, these pathways seem to be of little significance for recovery, as
the existence of these responses was not correlated with clinical
improvement. The unaffected hemisphere after stroke shows plastic changes
in motor output organization after a contralateral lesion.
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Reorganization of motor output in the non-affected hemisphere after stroke
Neurological Therapy Centre, Heinrich-Heine-University Dusseldorf, Germany.
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